Survival of early posthematopoietic stem cell transplantation relapse of myeloid malignancies.

de Jong, Greta; Janssen, Jeroen J W M; Biemond, Bart J; Zeerleder, Sacha S.; Ossenkoppele, Gert J; Visser, Otto; Nur, Erfan; Meijer, Ellen; Hazenberg, Mette D (2019). Survival of early posthematopoietic stem cell transplantation relapse of myeloid malignancies. European journal of haematology, 103(5), pp. 491-499. Wiley-Blackwell 10.1111/ejh.13315

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OBJECTIVE Relapse of AML after allogeneic hematopoietic stem cell transplantation (HSCT) has a poor prognosis, and standard of care therapy is lacking. Early (<6 months) relapse is associated with dismal outcome, while the majority of relapses occur early after transplantation. A more precise indication which patients could benefit from reinduction therapy is warranted. METHODS We retrospectively analyzed outcomes of 83 patients with postallogeneic HSCT relapse. Patients were divided based on intention to treat (curative vs supportive care). RESULTS Of the 50 patients treated with curative intent, 44% reached complete remission (CR) upon reinduction chemotherapy, and of these patients, 50% survived. Two survivors reached CR after immunotherapy (donor lymphocyte infusion (DLI), without reinduction chemotherapy). Sixty-nine percent of the survivors had received high-intensity cytarabine treatment, followed by immunologic consolidation. Relapse <3 months after transplantation was predictive for adverse survival (P = .004), but relapse <6 months was not. In fact, >50% of the survivors had a relapse <6 months. CONCLUSION We confirmed the dismal prognosis of postallogeneic HSCT relapse. Importantly, our data demonstrate that patients fit enough to receive high-dose chemotherapy, even when relapse occurred <6 months, had the best chance to obtain durable remissions, in particular when immunologic consolidation was performed after reaching CR.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Hämatologie (Erwachsene)

UniBE Contributor:

Zeerleder, Sacha Sergio

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0902-4441

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Pierrette Durand Lüthi

Date Deposited:

23 Sep 2019 10:26

Last Modified:

22 Oct 2019 18:42

Publisher DOI:

10.1111/ejh.13315

PubMed ID:

31411761

Uncontrolled Keywords:

acute myeloid leukemia allogeneic hematopoietic stem cell transplantation graft-versus-leukemia outcome

BORIS DOI:

10.7892/boris.133391

URI:

https://boris.unibe.ch/id/eprint/133391

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